Of Nanoprobes and Knees: Looking at the History and Pop Culture of Implants

This week a story on a recent breakthrough for dissolvable medical implants got me thinking about humanity’s past with implants and medical devices. Obviously, the clear place for my Science Fiction addled, overly geekified brain to jump to was Star Trek and the Borg.

Don’t Judge me.

Star Trek has a long-term relationship with technology and innovation, inspiring many technological advances, albeit mostly non-health-related ones. However, the Borg represented the potential darker side of technology and misuse of it, particularly in the realm of body modification and cybernetic implants. With their crazy ocular devices, robotic limbs and constant uplink to the Collective, the Borg terrified me when I watched First Contact as a kid. In retrospect, I see a lot of similarities between where we are today with medical device implants, crazy homemade devices and discoveries like those dissolvable implants and the Borg. My goal for this week was to first look at a brief of implants and medical devices in humans, and then to take a look at some of the very Borg-like technologies we use today. As a disclaimer, I in no way claim to be an expert either on Star Trek or the field of devices and implants (which is very wide, and overly simplified here), but instead put myself forward as a geek with too much time on her hands, and too much access to the internet and all the glorious things you can learn on it.

With the broadest interpretation, humanity has been mucking around with implants for quite some time. However,Mayan and Egyptian dental implants, frequent attempts at hip replacements since the 1800s, and George Washington’s (not so) wooden teeth aside,the more modern approach to implants and medical devices goes back to roughly 1940s, when Dr. Austin Moore performed the first (metallic) hip replacement. In 1954 Leslie Gordon Percival Shiers published his preliminary report on the design and outcomes of the first knee replacement surgeries. Paul Winchell patented the first design for an artificial heart in 1956, with the assistance of Dr. Henry Heimlich (yes, *that* Dr. Heimlich). The first total artificial heart transplant was performed in 1969 by Dr. Denton Cooley, without authorization, and kept the patient alive for three days before a donor heart was found to replace it.

In 1976, recognizing the importance of oversight of the rapidly developing field of medial devices congress added the Medical Devices Amendments to the Federal Food, Drug and Cosmetic Act (FD&C). This placed the approval of medical devices for marketing in the United States under the responsibility of the Food and Drug Administration, where it has remained ever since, albeit with a few updates. These days, 3-4,000 applications are submitted to the FDA each year for approval. More importantly, the complexity of the devices has substantially increased. The Institute of Medicine’s report on the FDA’s approval process in 2001 showed that the average number of pages in each application has more than doubled from 164 pages in 1993 to 369 pages in 2008, almost entirely because of the increased complexity of medical devices. (Pages 149-52)

The current state of medical devices, implants and crazy cyborg-like technology is rapidly advancing. These days a large portion of implant-tech (medical or otherwise) is venturing much further into “Borg Territory”. Borg “Nanoprobes” have been realized in the form of nanotechnology, which can be used for almost anything ranging from monitoring heart attacks and cancer growth, to creating a ruckus over sunscreen safety , to developing a carbon nanotube ‘yarn’ that can serve as artificial muscle. The ocular implants of The Borg aren’t off limits either. Steve Mann created his own system in the 1980s and though the current version looks relatively normal, the first few iterations of his design are definitely Borg-like in appearance. Most of technological and implant developments that I found seem to lack the more sinister implications of Borg technology. It’s probably still to early to tell if our society will keep it that way, or manage to mess it up somehow, but I think I’d rather take the positive outlook than the negative. I could continue to list off various contributions of the Borg and Star Trek to technology and the ever-advancing field of cybernetics, implants and medical devices, but there are too many to count.

Besides, someone let William Shatner make an entire two-hour special on the topic and let’s face it, he’s much funnier than I am.

[Edit for clarification: I made a mistake in my Star Trek terminology, nanites are a Federation technology which later became sentient (and unionized), nanoprobes are the Borg technology. The title and text were updated to reflect this]

Shara,
As a not very hidden Trekkie this was a great hook. My only worry is that others have not watched as much Star Trek as I have. About the subject, It was kind of cool to have a little history of implants. Since this is such a broad subject, you might have wanted to focus on a certain type of implant instead of a history of all of them for a short post like this. Otherwise excellent choice and I would love to know more history of medical implants. How effective are medical implants at this point?

Thanks for the feedback Margaret! You have a definite point about the star trek references, so i tried to give broad categories of what i was looking at and some background on them as well. I’m debating on following up with another post on this specifically just looking at one kind of implants, like knee prostheses, so that i can get deeper into the evolution of it. In terms of effectiveness, that’s probably on a product-by-product basis, although i remember seeing a statistic somewhere in my readings that there are roughly 230,000 hip replacement surgeries performed every year, so i’d hazard they are viewed as being pretty effective. Unfortunately, i could not for the life of me find the reference i read that in, and all of my searches today are only giving information on breast implants.

I think the cyborg comparison is very apt. Many people in my family are talking about their ‘replacement parts’. I agree with Margaret that the post is very dense in terms of information, especially with dates, figures and TV references in the mix. I personally find that such general overviews work either best as a book or as a ‘horrible history’ style cartoon (you could do a borg-implant cartoon?), but that’s maybe just me.

Talking of hip replacements, my aunt painfully found out that there are very different types of hip replacements. When she fell a couple of years ago on a hidden ice surface, the doctors gave her a hip for older people who are not very active, but she didn’t find out over a year later. My aunt is super active and does lots of sports despite being over 80 years old, but has had to stop most of this stuff, because the new/wrong hip will not allow her to do those things. Either she has to have another (risky at her age) operation and start all the physiotherapy from the beginning again or she will have to confine herself to the sofa. No one in the family knew that there were different types of replacements, either and everyone is paranoid now to be given the wrong part, especially in an emergency situation where the patient may be inarticulate and doctors just look at the age of the patient and not the fitness level. For me this raised a lot of questions about health inequalities, assumptions, life-style demands on implants, new life-styles of presents/future aging populations, decision-making around implants etc. So, yes, implants are definitely a hot topic! Also did some work on nano/biotechnology and medicine, but that’s another story… Looking forward to your future posts! (As they say in both Star Trek and STS: ‘Engage!’)

Angela,
Thank you so much for your suggestions! I definitely wrestled with trying to make the history content as un-boring and possible but wasn’t having much luck. I love the idea of making a comic!

I knew there were a wide variety of hip replacements available, but i hadn’t realized they were differentiated by expected activity levels. I wonder if anyone’s looked into adverse effects associated with getting the wrong model for your life style? Maybe the sedentary ones with ‘active’ hips have problems because of less shock absorption or something along those lines?

Hi Shara! I agree with the others that you used an interesting and fun hook. I was a little puzzled by your references to nanosunscreens and ‘nano’ monitoring heart attacks and cancer growth since they seemed unnecessary in a piece devoted to implants. Plus, you didn’t have any recent information about nanotechnology-enabled implants.

I enjoyed the historical context although with an entire paragraph on US law (Medical Devices Amendments …) is of little interest to me since I do not live in nor am I citizen of the US.

One thing I would suggest: “Don’t judge me” puts your reader in the position of having judged you when that may not have been the case. It’s the kind of thing that you can get away with saying but is much harder to pull off in written form.

It’s a lively piece but I think you got a little carried away and tried to pull a bunch of disparate pieces of information together without following through on the promise in your headline. I see a genuine joy in communication accompanied by a lack of focus. Speaking as someone with the same issue, I still find focus difficult, even after 25 years writing professionally, but it makes a huge difference in the quality of your work and its impact. Good luck and all the best, Maryse

In the end i think you’re right about being pulled into too many different directions. The sad part is that this is maybe 25% of all the different stuff i had initially tried to shove into the piece. This may have been a little bit reflected in the density of the paragraphs. As someone who has similar joy/focus issues, how do you manage to focus your thoughts for writing? I’d love to know what methods you have!

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About Mind The Science Gap

Mind The Science Gap was a Science Communication Training blog that ran between 2012 - 2013.

Each semester, ten Master of Public Health students from the University of Michigan participated in a course on Communicating Science through Social Media. Each student on the course was required to post weekly articles here as they learned how to translate complex science into something a broad audience can understand and appreciate. And in doing so they were evaluated in the most brutal way possible - by the audience they were writing for!